Zhuge Ying, Cheung Michael C, Yang Relin, Eldick Dalal, Koniaris Leonidas G, Sola Juan E
Division of Pediatric Surgery and Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
J Surg Res. 2009 Sep;156(1):95-102. doi: 10.1016/j.jss.2009.03.054. Epub 2009 May 3.
The outcomes of pediatric intestinal foregut and small bowel solid tumors have never been studied on a population scale.
The Surveillance, Epidemiology, and End Results database (1973-2005) was queried for all patients under 20 y of age.
A total of 105 cases of pediatric intestinal foregut and small bowel solid tumors were identified. Tumors occurred in the esophagus (8.6%), stomach (61%), and small bowel (30.5%). The most common histologies include sarcoma (43.8%), which consisted mostly of gastrointestinal stromal tumors (GIST), carcinoma (41.0%), which consisted mostly of adenocarcinomas, and neuroendocrine tumors (NET) (10.5%). Most tumors were poorly differentiated and presented with advanced disease. The overall median survival time was 207 mo. Gastric solid tumors had significantly worse 5- and 10-y survival compared with their small bowel counterparts, though this difference disappeared in those who received surgical resection. Patients with carcinoma had significantly worse survival compared with those with sarcoma or NET, regardless of site and surgical intervention. Univariate analysis identified race, differentiation, stage, and surgery as significant predictors of survival. Multivariate analysis revealed that African American race, advanced stage of disease, carcinoma histology, and failure to undergo surgical extirpation were all independent predictors of worse outcome. In patients with carcinoma, failure to undergo radiotherapy was also a predictor of worse outcome.
Surgery is associated with a significantly improved survival for pediatric patients with solid tumors of the intestinal foregut and small bowel. Radiotherapy appears to be an important adjuvant therapy for patients with carcinoma.
小儿肠道前肠和小肠实体瘤的预后从未在人群规模上进行过研究。
查询监测、流行病学和最终结果数据库（1973 - 2005年）中所有20岁以下的患者。
共识别出105例小儿肠道前肠和小肠实体瘤。肿瘤发生于食管（8.6%）、胃（61%）和小肠（30.5%）。最常见的组织学类型包括肉瘤（43.8%），其中大多为胃肠道间质瘤（GIST）；癌（41.0%），其中大多为腺癌；以及神经内分泌肿瘤（NET）（10.5%）。大多数肿瘤分化差且呈现为晚期疾病。总体中位生存时间为207个月。胃实体瘤的5年和10年生存率明显低于小肠实体瘤，不过在接受手术切除的患者中这种差异消失。无论肿瘤部位和手术干预情况如何，癌患者的生存率明显低于肉瘤或NET患者。单因素分析确定种族、分化程度、分期和手术是生存的显著预测因素。多因素分析显示，非裔美国人种族、疾病晚期、癌组织学类型以及未接受手术切除均是预后较差的独立预测因素。在癌患者中，未接受放疗也是预后较差的一个预测因素。
手术与小儿肠道前肠和小肠实体瘤患者的生存率显著提高相关。放疗似乎是癌患者的一种重要辅助治疗方法。
